Surfactant Administration via Thin Catheter during Spontaneous Breathing: Randomized Controlled Trial in Alzahra hospital

Abstract

<em>Introduction</em> <br/>Respiratory distress syndrome (RDS) is a current cause of morbidity in premature infants resulted from surfactant deficiency. The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (TEC) and compare its outcomes with the InSurE (Intubate, Surfactant, Extubate) procedure <br/><br/><em>Materials and Methods</em> <br/>Premature infants with RDS, who were ≤ 32 weeks old and stabilized with nasal continuous positive airway pressure (nCPAP), were randomized to receive surfactant either by the TEC or InSurE technique. Tracheal instillation of 200 mg/kg Curosorf via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group (n=38). In the InSurE group (n=40), infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately <br/><br/><em>Results</em> <br/>Necrotizing enterocolitis rate was significantly lower in TEC group, than InSurE group, [p<0.02, RR=0.49, CI=%95(0.39_0.62)]. But rate of other morbidities did not significant difference between two groups. Although Mechanical ventilation duration did not significant different between two groups (p=0.2), but Total CPAP duration was shorter in TEC group, significantly [P<0.01, RR=8.2, CI=%95 (-37.9_-4.8)]. Need for O2 supplement and mean of total hospital duration was also lower in TEC group, but was not significant, statistically <br/><br/><em>Conclusion</em> <br/>The TEC technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight and decreases total nCPAP duration, significantly. But Judgment of substitution TEC instead of InSurE as a routine technique need to more studies.